Overview
Project BOOST® Implementation Toolkit

The
BOOSTing (Better Outcomes by Optimizing Safe Transitions) Care Transitions implementation toolkit provides a wealth of materials to
help you optimize the discharge process at your institution.
The tools and approach are based on principles of quality improvement (QI), evidence-based medicine, as well as personal and institutional experiences.

Originally, the BOOST Implementation toolkit was developed in 2008 through support from the John A. Hartford Foundation and has been continued to be revised and improved over the years. In 2014, SHM developed a revised 2nd edition of the guide that incorporated the latest literature on transitions of care as well as the experiences of lessons learned from the Project BOOST mentoring program's mentors (faculty experts) and participating BOOST hospitals (more than 180 in US and Canada).
The Guide is laid out in a user-friendly, step by step method with explicit instructions and worksheets to help new sites engage with Project BOOST, build effective QI teams, and improve the care of their patients as they transition out of the hospital.

The BOOSTing (Better Outcomes by Optimizing Safe Transitions) Care Transitions Implementation Toolkit is the online version of the CareTransitions Implementation Guide. The suggested approach is based on 8 essential elements for improving the discharge process.

The implementation toolkit will walk you through each step of designing, implementing and evaluating your intervention. We recommend that you go through each section, in the order presented in the yellow portion of the navigation bar at the top of each page. However, if you are already familiar with the content of a particular section, skip ahead.

The toolkit also includes a wealth of other resources, (within the blue portion of the navigation bar at the top of each page) including Educational Resources (review of key literature, teaching slide sets, patient education and more) and Clinical Tools. Finally, for a refresher on Quality Improvement basic principles, visit QI Basics.

Review the literature for transitions from the inpatient to outpatient care setting and identify related guidelines and core measures. Following, select (or tailor) a protocol or series of tools that is aligned with the scope and goals of your project.

Qualitative analysis: diagram care delivery to identify steps in care transitions that may be unnecessary or may contribute to non-value-added variation in practice. Likewise, identify areas that are either missing or need important redundancy.

Quantitative analysis: analyze outcomes of discharge processes in a way that your project team can react to effectively.

Collect data needed to track performance on key metrics. Plot and report data graphically using a run chart. Write an aim statement to clearly identify what your team has targeted to improve. Consider tracking balancing measures, so that improvement in one area is not accompanied by a decrease in performance in another area.

Key metric #2: Care Transitions Process Measures such as how well are patients prepared for discharge or caregivers prepared in caring for the patient post-discharge, what proportion of follow-up clinicians receive communication regarding the patient’s hospitalization and follow-up issues at time of discharge.

The BOOST intervention suggests core metrics for improvement and provides a set of tools that can be used in their entirety, or modified to meet a site’s specific needs. Utilizing the BOOST approach you can:

Learn by testing and refining change in the clinical setting. Revise the protocols and order sets to embrace appropriate variation. Take steps to weed out inappropriate variation. Spread your improvements to other units.

Learning in the clinical setting: Plan-Do-Study-Act.

Spreading improvement to other units.

Why Should You Act?

Hospitalists,
by definition, introduce discontinuity in care as patients transition
from outpatient provider, to the hospital medicine service, and then
back to outpatient provider.

Inadequately
performed care transition can lead to multiple negative consequences
such as decreased patient understanding, medication errors, increased
stress on the caregiver, increased readmission rates, and an increase
in care costs.

Collaboration
between health care providers has been shown to improve these outcomes,
as well as patient satisfaction and quality of life.

Fundamental
Principle for Care Transitions

Communication
between care providers is an essential part of medical care that
influences patients' quality of life and effective disease treatment.
Hospitalists can act as leaders to educate both patients and providers
regarding appropriate steps to take to improve care transitions, and
reduce risks associated with these transitions.

Disclaimer
The implementation toolkit is an online resource for visitors to the Society of Hospital Medicine's website. All content and links have been reviewed by the BOOST Project Team, however the Society of Hospital Medicine does not exercise any editorial control over content associated with the external links that have been made available via this website.